Healthcare Provider Details

I. General information

NPI: 1235788639
Provider Name (Legal Business Name): MUNSON HEALTHCARE GRAYLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S MOUNT TOM RD
MIO MI
48647-9518
US

IV. Provider business mailing address

1321 S MOUNT TOM RD
MIO MI
48647-9518
US

V. Phone/Fax

Practice location:
  • Phone: 989-275-1200
  • Fax: 989-275-1210
Mailing address:
  • Phone: 989-275-1200
  • Fax: 989-275-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BONNIE KRUSZKA
Title or Position: COO MUNSON PHYSICIAN NETWORK
Credential:
Phone: 231-935-4995